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Purchase Order Form <br />Account Manager JISR Trish Lundeen <br />Cell Phone 425-483-5640 <br />Company Name <br />Contact or Department <br />Street Address <br />Addt'I Address Line <br />City, ST ZIP <br />Phone <br />Authorized Customer Initials <br />stryker <br />Purchase Order Date <br />Expected Delivery Date <br />Stryker Quote Number 10447165 <br />Company Name <br />Contact or Department <br />Street Address <br />Addt'I Address line <br />Citv, ST ZIP <br />Authorized Customer Initials <br />DESCRIPTION QTY TOTAL <br />Reference Quote: 10447165 <br />1 <br />$19,855.01 <br />Accounts Payable Contact Information <br />Name: <br />Email: <br />Phone: <br />Authorized Customer Signature <br />Printed Name: <br />Title: <br />Signature: <br />Date: <br />Attachment: Stryker Quote Number 10447165 <br />V I NL- $15,855.01 <br />Stryker Terms and Conditions <br />www.strykeremergencycare.com/terms <br />' Sales or use taxes on domestic (USA) deliveries will be invoiced in addition to the price of the goods and services on the Stryker Quote <br />